标题：超声可视下前锯肌深面阻滞用于单孔胸腔镜手术对老年NSCLC患者术后疼痛、心肌酶谱的影响

      作者：郭永强 1，粟付民 1，韩灵龙 1，王洋洋 2    1.许昌市中心医院麻醉科，河南 许昌 461000；2.河南省人民医院麻醉科，河南 郑州 450000

      卷次： 2023年34卷9期

      【摘要】 目的 探究超声可视下前锯肌深面阻滞用于单孔胸腔镜手术在老年非小细胞肺癌(NSCLC)患者治疗中的临床优势。方法 选取2020年11月至2022年3月许昌市中心医院拟行单孔胸腔镜手术的734例NSCLC患者作为研究对象，按随机数表法分为对照组和观察组各367例。对照组患者给予静吸复合全身麻醉，观察组患者给予超声可视下前锯肌深面阻滞复合全身麻醉。比较两组患者围术期指标、苏醒质量和不良反应，以及麻醉诱导前(T0)、术后即刻(T1)、术后6 h (T2)、术后24 h (T3)的心肌酶谱[肌钙蛋白T (cTnT)、磷酸肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]水平和T1、T2、T3时的疼痛程度评分(VAS)。结果 观察组患者的丙泊酚、舒芬太尼用量分别为(618.76±30.15) mg、(68.97±5.87) μg，明显少于对照组的(573.93±28.64) mg、(76.52±6.42) μg，差异均有统计学意义(P<0.05)；观察组患者的睁眼时间、自主呼吸时间、拔管时间分别为(16.45±4.28) min、(11.35±2.94) min、(20.87±4.98) min，明显短于对照组的(18.75±4.31) min、(12.76±2.89) min、(23.15±5.39) min，苏醒期躁动评分为(0.95±0.26)分，明显低于对照组的(1.73±0.35)分，差异均有统计学意义(P<0.05)；T2、T3时，观察组患者的 cTnI水平分别为(7.52±1.39) pg/mL、(8.31±1.32) pg/mL，明显低于对照组的(9.48±1.46) pg/mL、(9.22±1.28) pg/mL，差异均有统计学意义(P<0.05)；T1、T2、T3时，观察组患者VAS评分分别为(0.19±0.05)分、(1.19±0.37)分、(1.89±0.39)分，明显低于对照组的(0.52±0.13)分、(3.25±0.84)分、(2.11±0.41)分，差异均有统计学意义(P<0.05)；观察组患者的不良反应发生率为17.71%，明显低于对照组的28.61%，差异有统计学意义(P<0.05)。结论 超声可视下前锯肌深面阻滞用于老年NSCLC患者单孔胸腔镜手术能减少麻醉药物剂量，降低对心肌功能的影响，缓解患者术后疼痛，提高苏醒质量及治疗安全性。
      【关键词】 非小细胞肺癌；胸腔镜手术；前锯肌深面阻滞；疼痛；心肌酶谱
      【中图分类号】 R734.2 【文献标识码】 A 【文章编号】 1003—6350（2023）09—1267—05

Effects of deep block of serratus anterior muscle under ultrasound visualization for single hole thoracoscopicsurgery on postoperative pain and myocardial enzymes in elderly patients with non-small cell lung cancer.
GUOYong-qiang 1, LI Fu-min 1, HAN Ling-long 1, WANG Yang-yang 2. 1. Department of Anesthesia, Xuchang Central Hospital,Xuchang 461000, Henan; CHINA; 2. Department of Anesthesia, Henan Provincial People's Hospital, Zhengzhou 450000,Henan, CHINA
【Abstract】 Objective To explore the clinical advantages of deep block of serratus anterior muscle under ultra-sound visualization for single hole thoracoscopic surgery in the treatment of elderly non-small cell lung cancer (NSCLC)patients. Methods A total of 734 patients with NSCLC undergoing single hole thoracoscopic surgery in Xuchang Cen-tral Hospital from November 2020 to March 2022 were selected as research objects. According to the random number ta-ble, they were randomly divided into a control group and an observation group, with 367 patients in each group. The pa-tients in the control group were given intravenous inhalation combined with general anesthesia, while the patients in theobservation group were given deep block of serratus anterior muscle under ultrasound visualization combined with gen-eral anesthesia. Perioperative indicators, quality of recovery, and adverse reactions were compared between the twogroups, as well as the levels of myocardial enzymes [troponin T (cTnT), phosphocreatine kinase (CK), creatine kinaseisoenzyme (CK-MB), lactate dehydrogenase (LDH)] before anesthesia induction (T0), immediately after surgery (T1),6 hours after surgery (T2), and 24 hours after surgery (T3), and the Visual Analogue Scale (VAS) score at T1, T2, and T3.Results The dosage of propofol and sufentanil in the observation group were (618.76±30.15) mg and (68.97±5.87) μg,respectively, which were significantly less than (573.93±28.64) mg, (76.52±6.42) μg in the control group (P<0.05).The open eye time, spontaneous breathing time, and extubation time in the observation group were (16.45±4.28) min,(11.35±2.94) min, and (20.87±4.98) min, respectively, which were significantly shorter than (18.75±4.31) min, (12.76±2.89) min, and (23.15±5.39) min in the control group, while the score of restlessness in the recovery period was (0.95±0.26) points, significantly lower than (1.73±0.35) points in the control group (P<0.05). At T2 and T3, the cTnI levels inthe observation group were (7.52±1.39) pg/mL and (8.31±1.32) pg/mL, respectively, which were significantly lower than(9.48±1.46) pg/mL and (9.22±1.28) pg/mL in the control group (P<0.05). At T1, T2, and T3, the VAS scores in the obser-vation group were (0.19±0.05) points, (1.19±0.37) points, and (1.89±0.39) points, which were significantly lower than(0.52±0.13) points, (3.25±0.84) points, and (2.11±0.41) points in the control group (P<0.05). The incidence of adverse re-actions in the observation group was 17.71%, which was significantly lower than 28.61% in the control group (P<0.05).Conclusion Deep block of serratus anterior muscle under ultrasound visualization for single hole thoracoscopic sur-gery in elderly patients with NSCLC can reduce the dose of anesthetic drugs, reduce the impact on myocardial function,alleviate postoperative pain, improve the quality of recovery and treatment safety.
      【Key words】 Non-small cell lung cancer; Thoracoscopic surgery; Deep block of serratus anterior muscle; Pain;Myocardial zymogram